NPIMap

Individual provider Active NPI

Mark Irwin Petersen, MD

  • Internal Medicine Physician
  • Tonganoxie, KS
National Provider Identifier
1881647543
Registry record updated Oct 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0421601 Issued in KS
Practice address
21107 Donahoo Rd
Tonganoxie, KS 66086-4153
Phone
(913) 742-4084
Fax
(913) 742-4086
NPI assigned
May 17, 2006
Last updated
Oct 8, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 04-21601 KS
Internal Medicine Physician 207R00000X 0421601 KS Primary

Addresses

Primary practice location

21107 Donahoo Rd
Tonganoxie, KS 66086-4153

Mailing address

PO Box 996
Tonganoxie, KS 66086-0996
Phone (913) 742-4084

Other identifiers 3

IdentifierTypeStateIssuer
2050317102OtherRAILROAD MEDICARE
100135660BMedicaidKS
13217089OtherBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120303000026 KS Practitioner - Internal Medicine 9133190168 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Kansas School of Med (KC/Wich/Sal), 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mid America Senior Management Aco LLCGroup PAC ID 1456896190, 3 clinicians
Mid America Senior Management LLCGroup PAC ID 6406827435, 3 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians
Theoria MedicalGroup PAC ID 5395098339, 317 clinicians

Practice addresses (Care Compare)

21107 Donahoo Rd
Tonganoxie, KS 66086-4153
Phone (913) 742-4084

2600 Compass Rd
Glenview, IL 60026-8001

749 Blake St
Edwardsville, KS 66111-1338
Phone (913) 422-5952

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
37.04 of 100Reported as individual
Quality
15
Improvement activities
0
Cost
70.13

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0421601KSMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Complexcare Medical Group Kansas H LLC Internal Medicine CurrentSince Dec 30, 2025 Accepting new patients
Mid America Senior Management Aco LLC Internal Medicine CurrentSince Jun 1, 2024 Accepting new patients
Theoria Medical Internal Medicine CurrentSince Oct 21, 2024 Accepting new patients
Hospitalist Medicine Physicians of Texas, PLLC Internal Medicine CurrentSince Oct 1, 2024 Accepting new patients
Mid America Senior Management LLC Internal Medicine CurrentSince Apr 1, 1999 Accepting new patients
Recover-Care Richmond LLC Past Accepting new patients
Recover-Care Meadowbrook Rehabilitation LLC Past Accepting new patients
Lansing Operator, LLC Past Accepting new patients
Eskridge Operator, LLC Past Accepting new patients
Wakefield Operator, LLC Past Accepting new patients
Colby Operator, LLC Past Accepting new patients
Recover-Care Emporia LLC Past Accepting new patients
Recover-Care Louisburg LLC Past Accepting new patients
Kaw River Operator, LLC Past Accepting new patients
Edwardsville Operator, LLC Past Accepting new patients
Pittsburg Operator, LLC Past Accepting new patients
Bonner Springs Living, LLC Past Accepting new patients
Galena Nursing & Rehab, LLC Past Accepting new patients
HMG Park Manor of Westwood, LLC Past Accepting new patients
Quaker Hill Nursing, LLC Past Accepting new patients
Providence Opco, LLC Past Accepting new patients
Tonganoxie Opco LLC Past Accepting new patients
Parkway Operator, LLC Past Accepting new patients

Locations (25 of 35)

605 E Melvin St
Arma, KS 66712
Phone (620) 347-4103

232 Elm St
Baldwin City, KS 66006
Phone (785) 594-2603

424 Washington St
Baldwin City, KS 66006
Phone (785) 594-2603

520 E Morse Ave
Bonner Springs, KS 66012
Phone (913) 441-2515

2725 Church St
Eudora, KS 66025
Phone (785) 363-5150

1220 E 8th St
Galena, KS 66739
Phone (620) 679-0234

223 Bedford St
Gardner, KS 66030
Phone (913) 677-0500

427 W Main St
Gardner, KS 66030
Phone (913) 681-5871

869 S Juniper Ter
Gardner, KS 66030
Phone (913) 427-0093

749 Blake St
Kansas City, KS 66111
Phone (913) 422-5952

750 Blake St
Kansas City, KS 66111
Phone (913) 422-5832

751 Blake St
Kansas City, KS 66111
Phone (405) 239-0261

657 W Eisenhower Rd
Lansing, KS 66043
Phone (913) 228-1918

5150 Hughes Rd
Leavenworth, KS 66048
Phone (913) 297-2477

11661 Granada St
Leawood, KS 66211
Phone (816) 708-1661

15055 W 87th Street Pkwy
Lenexa, KS 66215
Phone (913) 305-5829

8740 Caenen Lake Rd
Lenexa, KS 66215
Phone (913) 565-2133

9100 Park St
#202B
Lenexa, KS 66215
Phone (913) 438-4286

1200 S Broadway St
Louisburg, KS 66053
Phone (913) 837-2916

202 S Rogers Rd
Louisburg, KS 66053
Phone (913) 254-9273

20333 W 151st St
Olathe, KS 66061
Phone (888) 960-1393

791 N Somerset Ter
Olathe, KS 66062
Phone (913) 297-2449

1520 Parker Ave
Osawatomie, KS 66064
Phone (913) 427-0107

11000 Oakmont St
Overland Park, KS 66210
Phone (913) 488-9303

12500 W 135th St
Overland Park, KS 66221
Phone (913) 374-2130

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Recover-Care Richmond LLCRichmond, KS, CCN 175444 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Feb 28, 2025
Apr 2, 2025
Louisburg Healthcare and Rehabilitation CenterLouisburg, KS, CCN 175238 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Feb 28, 2025
Feb 28, 2025
Flint Hills Care and Rehabilitation CenterEmporia, KS, CCN 175280 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Feb 28, 2025
Mar 12, 2025
Sunset Hospice LLCOverland Park, KS, CCN 171628 Hospice W-2 Managing Employee (50%) Aug 17, 2023

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 24

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 24

Hospital & facility affiliations 22

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 22

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728345600000",
    "number": "1881647543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 996",
            "city": "TONGANOXIE",
            "state": "KS",
            "postal_code": "660860996",
            "telephone_number": "913-742-4084",
            "fax_number": "913-742-4086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21107 DONAHOO RD",
            "city": "TONGANOXIE",
            "state": "KS",
            "postal_code": "660864153",
            "telephone_number": "913-742-4084",
            "fax_number": "913-742-4086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "MARK",
        "middle_name": "IRWIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "04-21601",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "0421601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "2050317102",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100135660B",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "13217089",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tonganoxie, KS

Sources for this page

Verify at the official NPI Registry.